Intake Representative (IVIG) at RE Pharmacy

Irvine, California, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Sep, 26

Salary

32.0

Posted On

25 Jun, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Insurance Verification, Patient Advocacy, Clinical Appeals, Case Management, Microsoft Office Suite, Conflict Resolution, Analytical Thinking, Problem Solving, Interpersonal Communication, Negotiation, Organizational Skills

Industry

Hospitals and Health Care

Description

About River’s Edge Pharmacy: River’s Edge Pharmacy has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians’ offices. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management. THE RIVER’S EDGE STORY River’s Edge Pharmacy started in Rancho Mirage, CA in 2008 to address the need for compassionate care by specialty pharmacies. In 2013, the Company moved to a larger facility in Palm Desert, CA. The successful execution of River’s Edge Pharmacy’s growth strategy led to the opening of a total of nine infusion locations and two pharmacies in California. Since the expansion, River’s Edge Pharmacy has become the specialty pharmacy and infusion service provider of choice for patients and physicians seeking exceptional expertise, human kindness, and professional guidance. The team of pharmacists, technicians, and care experts at River’s Edge Pharmacy serve as patient advocates by combining professional expertise with caring support. These services are all part of River’s Edge Pharmacy’s commitment to helping patients live better lives while navigating the complicated world of medicine and health insurance. Position Title: Intake Representative (IVIG) Department: Patient Services/Intake Report to: PCC Manager Position Type: Full-time Position Overview: Uses critical thinking skills and exercises independent decision-making as a member of team responsible for assisting our clients. Will gather and complete all necessary information needed for processing of prescriptions and/or care. The Intake Representative, will use sound judgment to coordinate externally with all referrals sources, insurance companies and patients on each pending referral. Intake Representatives will also be expected to work in cooperation with the pharmacist and other ancillary staff to ensure the completion of the order. Primary Responsibilities: * Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty. * Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned. * Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization. * Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office. * Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status. Obtains approval information and activates copay cards based off of eligibility and specific drug prescribed. * Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy. * Build and maintain effective business relationships with prescribers treating assigned set of disease states and provide ongoing communication of specific case-related information as appropriate. * Completes a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required. * Receive notification of patients in need of financial assistance to cover the cost of their prescriptions. Communicate with patients to provide information regarding assistance programs and community resources that provide the required assistance. * Obtain required information and permission from patients and submit electronic applications for financial assistance of their behalf, or provide patients with forms required by assistance providers, follow up to offer assistance to complete documents properly, and ensure that applications are filed in keeping with defined time limits to avoid interruption in therapy. * Follow up with assistance providers to determine the status of applications, expedite consideration of requests, advocate on behalf of patients, and track the status of applications and related activity. * Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records. Ensure that work activities are conducted in compliance with regulatory requirements and the organization’s defined standards and procedures, and in a manner that provides the best available level of service and quality. * Accurate and timely processing of new specialty pharmacy referrals with a strong emphasis on IVIG (Intravenous Immunoglobulin) therapies. Plus – may perform other duties as assigned. Education: * High school diploma or equivalent required * Associate or Bachelor’s degree in healthcare, life sciences, or business preferred * CA BOP Pharmacy Technician License preferred Experience: * 5 or more years prior Pharmacy or experience. * 3 or more years prior experience with Specialty or Infusion Pharmacy medications. * Prior experience in processing Infusion therapy with strong emphasis on Ig therapy. Technical / Specialized Knowledge, Skills Abilities * Thorough knowledge of Specialty Pharmacy laws and regulations. * Proficient with Microsoft Office Suite or related software. * Excellent verbal and written communication skills. * Excellent interpersonal, negotiation, and conflict resolution skills. * Excellent organizational skills and attention to detail. * Strong analytical and problem-solving skills. * Ability to prioritize tasks and to delegate them when appropriate. * Ability to act with integrity, professionalism, and confidentiality. Working Conditions: * This is a full-time position in a professional office environment. * The role requires prolonged periods of sitting, frequent use of a computer and other standard office equipment, and occasional lifting of up to 20 pounds. * Regular attendance and punctuality are essential. Some evening or weekend work may be required based on business needs. Equal Opportunity Employer: We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.

Responsibilities

The Intake Representative is responsible for gathering patient information, verifying insurance benefits, and obtaining prior authorizations for specialty prescriptions. They coordinate between patients, physicians, and insurance companies to facilitate treatment access and manage clinical appeals.